Endothelial dysfunction in metabolic syndrome: Prevalence, pathogenesis and management

Τζιόμαλος, Κωνσταντίνος; Athyros, Vasilios G.; Karagiannis, Asterios; Mikhailidis, DP

doi:10.1016/j.numecd.2009.08.006

Cited by 150 publications

(94 citation statements)

References 59 publications

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“…Since all components of MetS have unfavourable effects on the endothelium, endothelial dysfunction more prevalent in patients with MetS and could play a role in the increased risk for cardiovascular disease and type 2 DM in this population (28). Many reported studies have used several modalities to investigate the relationship MetS and coronary microvascular circulation.…”

Section: Discussionmentioning

confidence: 99%

“…All the components of MetS (hypertension, dysglycemia, dyslipidemia, and obesity) can individually impair microvascular function (10,28,31). Exact mechanisms underlying impaired pharmacologic coronary vasodilation in MetS have not been clearly defined, but are likely related to altered functional expression of receptors and ion channels, endothelial and vascular smooth muscle function, paracrine and neuroendocrine influences, structural remodeling of coronary arterioles and/or microvascular rarefaction (9).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Tok¹,

Özcan²,

Kadife³

et al. 2013

AnadoluKardiyolDerg

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Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational studyMetabolik sendromlu hastalarda ekokardiyografik olarak gösterilen bozulmuş koroner akım rezervi artmış aort sertliği ile ilişkilidir: Gözlemsel bir çalışma ABSTRACTObjective: Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS. Methods: Forty-six patients (mean age 47.3±6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0±6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. Results: CFR was significantly lower in patients with MetS than in controls (2.3±0.2 vs 2.7±0.2, p<0.001). In the MetS group, aortic distensibility (10.4±3.5 cm 2 .dyn -1 .10 -6 vs. 12.7±3.4 cm 2 .dyn -1 .10 -6 , p=0.002) was decreased and AS was significantly increased (6.5±2.0 vs. 3.2±0.8, p<0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR. Conclusion: This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference. (Anadolu Kardiyol Derg 2013; 13: 227-34)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Tok¹,

Özcan²,

Kadife³

et al. 2013

AnadoluKardiyolDerg

View full text Add to dashboard Cite

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“…Other associated conditions are increased inflammation, vascular dysfunction, non-alcoholic fatty liver disease (NAFLD), polycystic ovary syndrome, sleep apnea and some types of cancer and dementia. 16,17,18,19,20,21,22,23,24 Obesity is commonly viewed as the cause of metabolic syndrome. However, while obesity is highly correlated with the condition, we (and others) suggest that it is the expansion of adipose stores beyond a person's individual storage capacity, 25,26 driven by and in conjunction with hyperinsulinaemia because of the overconsumption of processed dietary carbohydrates in the setting of a Western diet -so prevalent in modern society -that drives this disease process.…”

Section: Metabolic Syndrome As Pre-diabetesmentioning

confidence: 99%

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Cucuzzella

Tondt

Dockter

et al. 2017

JMH

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Background: Metabolic syndrome has become a significant problem, with the American Diabetes Association estimating the cost of diabetes and pre-diabetes in the United States alone to be $322 billion per year. Numerous clinical trials have demonstrated the efficacy of low-carbohydrate diets in reversing metabolic syndrome and its associated disorders.Aim: This study was designed to examine how voluntary adherents to a low-carbohydrate diet rate its effectiveness and sustainability using an online survey.Setting and methods: The 57-question survey was administered online and shared internationally via social media and ‘low-carb’ communities. Where appropriate, chi-squared tests and paired t-tests were used to analyse the responses.Results: There were 1580 respondents. The majority of respondents had consumed less than 100 g of carbohydrates per day for over a year, typically for reasons of weight loss or disease management. There was a reported decrease in waist circumference and weight with a simultaneous decrease in hunger and increase in energy level. Of those who provided laboratory values, the majority saw improvements in their HbA1c, blood glucose measurements, and lipid panel results. There was a reduction in usage of various medications, and 25% reported medication cost savings, with average monthly savings of $288 for those respondents. In particular, the usage of pain relievers and anti-inflammatories dropped with a simultaneous decreased rating of pain and increase in mobility.Conclusion: We conclude that low-carbohydrate diets are a sustainable method of metabolic syndrome reversal in a community setting.

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“…Among the conventional cardiovascular risk factors including; obesity, insulin resistance and hypertension, microvascular dysfunction is common (Davignon et al, 2004;Levy et al, 2008;Meigs et al, 2006;Tziomalos et al, 2010). Insulin itself has vasodilatory actions that augment the delivery of glucose to muscle cells, and this capacity seems to be impaired in states of insulin resistance and hypertension (Baron, 1994;Clark et al, 2003).…”

Section: Populärvetenskaplig Sammanfattningmentioning

confidence: 99%

Assessment of microvascular and metabolic responses in the skin

Iredahl¹

2016

Linköping University Medical Dissertations

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The general aim of this project was to develop experimental in vivo models that allow for minimally invasive investigations of responses in the skin to microvascular and metabolic provocations. The cutaneous microvasculature has emerged as a valuable model and been proposed to mirror the microcirculation in other organs. Dysfunction in the cutaneous microcirculation has thus been linked to systemic diseases such as hypertension and diabetes mellitus. Models for investigating skin responses could facilitate the understanding of pathophysiological mechanisms as well as effects of drugs. In the first study, three optical measurement techniques (laser Doppler flowmetry (LDF), laser speckle contrast imaging (LSCI) and tissue viability imaging (TiVi)) were compared against each other and showed differences in their ability to detect microvascular responses to provocations in the skin. TiVi was found more sensitive for measurement of noradrenaline-induced vasoconstriction, while LSCI was more sensitive for measurement of vascular occlusion. In the second study, microvascular responses in the skin to iontophoresis of vasoactive drugs were found to depend on the drug delivery protocol. Perfusion half-life was defined and used to describe the decay in the microvascular response to a drug after iontophoresis. In the third study, the role of nitric oxide (NO) was assessed during iontophoresis of insulin. The results showed a NO-dependent vasodilation in the skin by insulin. In the fourth study the vasoactive and metabolic effects of insulin were studied after both local and endogenous administration. Local delivery of insulin increased skin blood flow, paralleled by increased skin concentrations of interstitial pyruvate and lactate, although no change in glucose concentration was observed. An oral glucose load resulted in an increased insulin concentration in the skin paralleled by an increase in blood flow, as measured using the microdialysis urea clearance technique, although no changes in perfusion was measured by LSCI. The thesis concludes that when studying skin microvascular responses, the choice of measurement technique and the drug delivery protocol has an impact on the measurement results, and should therefore be carefully considered. The thesis also concludes that insulin has metabolic and vasodilatory effects in the skin both when administered locally and as an endogenous response to an oral glucose load. The vasodilatory effect of insulin in the skin is mediated by nitric oxide

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Endothelial dysfunction in metabolic syndrome: Prevalence, pathogenesis and management

Cited by 150 publications

References 59 publications

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal

Assessment of microvascular and metabolic responses in the skin

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